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Background: Non-suicidal self-injury (NSSI) has become a serious global problem among adolescents. This study aimed to explore the relationships between adverse childhood experiences, self-hate, and non-suicidal self-injury in adolescents., Methods: A total of 7009 adolescents participated in a survey from August 1 to December 31, 2023. The survey comprised the revised Adverse Childhood Experience (ACE) Questionnaire, Self-Hate Scale, and Adolescent Non-Suicidal Self-Injury Assessment Questionnaire. SPSS 22.0 was utilized for data entry and analysis. Spearman's correlation analysis was employed to examine the relationships between the variables. The bias-corrected nonparametric percentile bootstrap method was used to test the significance of the mediating effect., Results: Adverse childhood experiences, self-hate, and non-suicidal self-injury were positively correlated. Adverse childhood experiences directly affected self-injury without obvious tissue damage. Self-hate mediated the relationship between adverse childhood experiences and self-injury without obvious tissue damage. Adverse childhood experiences directly affected self-injury with obvious tissue damage. Self-hate mediated between adverse childhood experiences and self-injury with obvious tissue damage., Limitations: The data were cross-sectional, and the effects of adverse childhood experiences were not immediate. Further, because this was a subjective study, reporting bias was inevitable. Finally, future research should expand the discussion and improve the global relevance of the study., Conclusion: Self-hate mediates the relationship between adverse childhood experiences and NSSI in adolescents. This study explores the underlying mechanisms and influencing factors of NSSI in adolescents and provides important evidence-based support for the prevention and intervention of NSSI in adolescents with different characteristics to maintain adolescents' physical and mental health., Implications and Contribution: Given the close relationships found between adverse childhood experiences, self-hate, and non-suicidal self-injury (NSSI) in adolescents, it is crucial to address adverse childhood experiences to prevent and treat NSSI. Providing necessary psychological support and interventions can help foster positive self-awareness, enhance self-esteem and self-efficacy, reduce self-disgust, and mitigate the negative effects of adverse childhood experiences., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: Suicide ideation and attempts are increasing for individuals between the ages of 15 and 24. Emotion dysregulation is a common factor that has been linked to many risky behaviors including NSSI and suicidal ideation. The current study aimed to longitudinally examine how the onset and offset of NSSI associated with changes in emotion regulation domains and suicidal ideation in a community sample of adolescents., Method: Participants between the ages of 14-17 were asked about NSSI, emotion regulation, and suicide ideation at baseline and 6-month follow-up. Most adolescents reported no NSSI at either timepoint (n = 316; 83 %); 5 % (n = 20) reported NSSI at both time points, 6 % (n = 23) had onset NSSI, and 6 % (n = 23) had offset NSSI. NSSI change groups were compared on emotion regulation domains and suicide ideation across time., Results: Adolescents who consistently did or did not engage in NSSI across time did not report any changes in emotion dysregulation or suicide ideation. Adolescents who reported an onset of NSSI during the follow-up also reported an increase in lack of impulse control and suicide ideation severity. Adolescents who stopped engaging in NSSI during the follow-up reported significantly better impulse control, better access to emotion regulation strategies, and increased use of reappraisal., Conclusions: These results hold potential for interventions that help adolescents find alternative coping/emotion regulation strategies outside of NSSI use., Competing Interests: Declaration of competing interest The authors report no conflict of interests., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Objective: Childhood sexual abuse (CSA) is a well-established risk factor for a range of psychological and behavioral issues, including non-suicidal self-injury (NSSI), making it a critical area of research for understanding adolescent mental health. Despite its prevalence, the mechanisms underlying their relationship remain insufficiently explored. This study aims to explore the relationship between CSA and NSSI behavior, as well as the mediating role of social avoidance and the moderating role of perceived family support., Method: 1737 Chinese adolescents with a mean age of 14.86 years (SD = 1.65) from hospitals' psychiatric departments in nine provinces of China were recruited to complete surveys on CSA experiences, NSSI behavior, and social support., Results: The results suggested that the effect of CSA on adolescent NSSI behavior was mediated by social avoidance, and the effect of CSA on social avoidance and NSSI behavior varied by the level of perceived family support. CSA led to social avoidance and increased risk for NSSI behavior. Higher levels of perceived family support had a protective effect, which reduced the motives of social avoidance and NSSI behavior., Conclusion: These findings revealed the risk of CSA and emphasized the role of social avoidance as an NSSI motive and the protective role of perceived family support for adolescents experiencing CSA. The clinical implications emphasize the need for interventions targeting family support and alternative coping strategies in the Chinese context. Additionally, future research should explore the complexity of intra- and extra-familial abuse and the roles of peer and professional support., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2025 Elsevier B.V. All rights reserved.)

As a leading cause of adolescent death, suicidal and self-injurious related behaviors (SSIRBs) is a devastating global health problem, particularly among patients with psychiatric disorders (PDs). Previous studies have shown that multiple interventions can alleviate symptoms and reduce risks. This review aimed to provide a systematic summary of interventions (i.e., medication, physical therapy, psychosocial therapy) for the treatment of SSIRBs among Chinese adolescents with PDs. From inception to September 17, 2023, twelve databases (PubMed, CINAHL, ScienceDirect, PsycINFO, EMBASE, Cochrane Library, Clinical Trial, Web of Science, CEPS, SinoMed, Wanfang and CNKI) were searched. We qualitatively and quantitatively synthesized the included studies. Standardized mean differences (SMDs), risk ratios and their 95% confidence intervals (CIs) used the Der Simonian and Laird random-effects model. Fifty-two studies covering 3709 eligible participants were included. Overall, the commonly used interventions targeting SSIRBs and negative feelings in PDs adolescents with SSIRBs included psychosocial therapy (e.g., cognitive behavioral therapy), medication (e.g., antidepressants), and physiotherapy (e.g., repetitive transcranial magnetic stimulation). Importantly, quetiapine fumarate in combination with sodium valproate (SV) had positive effects on reducing self-injury behaviors score [SMD: -2.466 (95% CI: -3.305, -1.628), I 2  = 88.36%], depression [SMD: -1.587 (95% CI: -2.505, -0.670), I 2  = 90.45%], anxiety [SMD: -1.925 (95% CI: -2.700, -1.150), I 2  = 85.23%], impulsivity [SMD: -2.439 (95% CI: -2.748, -2.094), I 2  = 0%], as well as its safety in comparison with SV alone. No significant difference of adverse reactions was found by low-dose QF (P > 0.05). This review systematically outlined the primary characteristics, safety and effectiveness of interventions for Chinese PDs adolescents with SSIRBs, which could serve as valuable evidence for guidelines aiming to formulate recommendations., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: Non-suicidal self-injury (NSSI) is frequent in eating disorders (ED). The aim of this study was to describe NSSI among subjects hospitalised for anorexia nervosa (AN) who self-harm and factors associated with NSSI in this population., Methods: This study was part of a larger French longitudinal multi-centre study. Two hundred and two women with AN were recruited from inpatient treatment facilities for ED from 2009 to 2011. All participants fulfilled the DSM-5 diagnostic criteria of AN. Subjects with and without NSSI were compared for clinical characteristics and comorbidities in bivariate analyses. Logistic regression analysis was then used to identify factors associated with NSSI., Results: The mean age of the sample was 20.8 years (± 6.6). The mean BMI was 14.3 (± 1.5). Overall 36.1% had self-harmed in the past 6 months. The main factors that triggered NSSI were a feeling of physical or psychological unease (45.2%), feelings of anger (24.7%), an attempt to relieve discomfort (19.2%), and low self-esteem (16.4%). Lifetime major depressive disorder, suicide attempts and eating concerns were independently associated with NSSI., Discussion: ED symptoms were linked to NSSI, but psychiatric history also played a key role. This is consistent with hypotheses of common underlying transdiagnostic mechanisms linking emotional dysregulation to NSSI and ED., Level of Evidence: Level III, well-designed cohort or case-control analytic studies., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol was approved by the Ile-de-France III Ethics Committee and the French Data Protection Authority (Commission Nationale de l’Informatique et des Libertés, CNIL). EudraCT number: 2007-A01110-53, Clinical trials number: NCT00910169. In accordance with the Helsinki declaration, written informed consent was obtained before inclusion from each participant, as well from their parents for those who were under 18 years. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Nonsuicidal self-injury (NSSI) is posited to arise from a complex interaction of biopsychosocial factors, with impulsivity playing a critical role. Given that current research on the neural mechanisms underlying this hypothesis remains inconsistent and limited in scope, we sought to explore how NSSI behaviours are associated with impulsivity resulting from structural brain alterations., Methods: We recruited patients with NSSI behaviours and healthy controls from 11 psychiatric hospitals. We assessed the differences in impulse control between the 2 groups using the Barratt Impulsiveness Scale version 11 and the Attention Network Test. We also conducted T 1 -weighted magnetic resonance imaging (MRI) and diffusion tensor imaging. Finally, we analyzed the associations among brain structure, psychological characteristics, and self-injurious behaviour among patients with NSSI., Results: We included 293 patients with NSSI behaviours and 140 healthy controls. Among them, 182 patients with NSSI and 95 controls underwent the T 1 -weighted MRI and diffusion tensor imaging. Patients with NSSI showed increased impulsivity and alerting function, with the strongest correlation between NSSI frequency and motor impulsivity. Compared with controls, patients with NSSI exhibited decreased grey matter volume and increased white matter volume, with no significant difference in cortical thickness. Pathway analysis demonstrated that motor impulsivity significantly mediated the association between white matter volume and the NSSI frequency in the right superior frontal gyrus and right inferior parietal lobe. When examining the connecting fibre tracts in the right frontoparietal area, patients with NSSI showed decreased integrity of white matter microstructure in the right cingulum, right superior corona radiata, and the splenium of the corpus callosum., Limitations: Accurately measuring executive control linked to NSSI is challenging in cognitive behavioural tasks, as impulsive tendencies during NSSI occurrence are not effectively captured., Conclusion: Our findings suggested that motor impulsivity, a prominent psychopathological characteristic of NSSI, is primarily modulated by the frontoparietal regions. These results provide empirical neuroimaging evidence for the impaired impulse control observed in NSSI., Competing Interests: Competing interests:: None declared., (© 2025 CMA Impact Inc. or its licensors.)

Objectives: Lesbian and Gay people (LGP) experience higher rates of mental health difficulties, including self-harm, suicidal behaviours, as well as inequalities in health care, than their heterosexual peers. Dialectical Behaviour Therapy (DBT) is an evidence-based treatment for self-harm and suicidal behaviours, though there is little research on LGP's experiences of DBT. This research aims to explore LGP's experiences of completing a full DBT programme., Design: A qualitative design with semi-structured individual interviews was utilised. The results were analysed using Interpretative Phenomenological Analysis., Methods: Six lesbian and two gay adults, aged between 22 and 47 years, living in the United Kingdom took part. All participants had completed a full programme of DBT within the 2 years prior to the interview., Results: Four superordinate themes emerged from the data: (1) The DBT journey; (2) Connections and Sense of Community during DBT; (3) Sexuality both visible and invisible in DBT and (4) A Gender, Sexuality and Relationship Diverse (GSRD) affirmative future for DBT., Conclusions: Several clinical implications are suggested to improve DBT for LGP, for example to consider having other LGP within DBT groups, to create a more GSRD-affirming DBT (changes to the DBT manual, DBT therapists, DBT programme and physical DBT space), to adapt DBT techniques to manage sexuality-related difficulties and to adopt a GSRD-centric framework. Overall, DBT appears to be beneficial for LGP., (© 2024 The Author(s). Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society.)

Psychological treatments targeting emotion dysregulation in adolescents reduce nonsuicidal self-injury (NSSI) but predicting treatment outcome remains difficult. Identifying sub-groups based on repeated measurements of emotion dysregulation pre-treatment may guide personalized treatment recommendations. We used data from a recent trial evaluating internet-delivered emotion regulation therapy for adolescents with NSSI ( n  = 138). Latent profile analysis was used to identify sub-groups based on pre-treatment responses on the 16-item version of the Difficulties in Emotion Regulation Scale. The primary outcome was self-rated NSSI frequency during treatment, and secondary outcome was the proportion of participants with no NSSI 1-month post-treatment. Three sub-groups of emotion dysregulation were identified: low variability and low mean (Group 1), low variability and high mean (Group 2), and high variability and low mean (Group 3). Sub-groups did not differ in NSSI frequency during treatment (Group 2 IRR = 1.06 [95% CI 0.49-2.29], p  = .88; Group 3 IRR = 1.22 [95% CI 0.31-4.76], p  = .77). However, more participants in Group 1 compared to Group 2 abstained from NSSI at 1-month post-treatment (OR = 3.63 [95% CI 1.16-11.33], p  = 0.01). Latent profile analysis identified sub-groups predictive of NSSI absence post-treatment, demonstrating clinical utility.

Background: Deviating emotion perception affects the interpretation of emotional stimuli and is linked to maladaptive emotion regulation. In adolescents with non-suicidal self-injury (NSSI), it remains unclear whether emotion regulation is altered from the earliest stage of visual emotion perception. The early visual system decomposes visual scenes into various spatial frequencies, processes these components individually, and then integrates them to form perception. Altered processing of these frequencies impacts the decoding of emotional stimuli, influencing emotion regulation from the onset of perception., Methods: This study explored emotion perception in 42 adolescent patients with NSSI and 43 healthy controls. Participants judged images of faces for emotional or neutral expressions across sessions featuring happy and sad valence. Gaussian apertures at random locations unveiled different facial areas at distinct spatial frequencies in each trial for emotion classification. Images from correct emotion classification were used to train an image classifier distinguishing emotional from neutral facial expressions in >33,000 trials per group and valence., Results: Cross-validation demonstrated deviating performances between the NSSI and control models in classifying sad facial expressions, with the NSSI model more frequently misclassifying sad expressions as neutral. Layer-wise relevance propagation identified the underutilization of key facial features as contributors to the lower accuracy in the NSSI model. Further analyses revealed components of emotional competence as predictors of the utilization of specific facial regions for the classification of sad expressions., Conclusion: The disparity in identifying sad emotions suggests the utilization of different spatial frequency information as an emotion-specific avoidance strategy among adolescents with NSSI., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Cyberbullying victimization during adolescence may induce an increased risk for non-suicidal self-injury (NSSI). However, the longitudinal mediating mechanism underlying the association of cyberbullying victimization with adolescents' NSSI over time has not been studied fully., Objective: The current study aimed to examine the longitudinal mediating mechanism underlying relationship between cyberbullying victimization and NSSI. Based on Nock's (2009) integrated developmental model of NSSI, this study explored the mediating effects of psychological distress and maladaptive beliefs following cyberbullying victimization in this relationship., Participants and Setting: A total of 773 Chinese adolescents (48.4 % males, T3 mean age = 16.37 ± 0.49 years) participated in this study and completed self-report questionnaires., Methods: We employed a three-wave (called T1, T2, and T3) longitudinal design. The participants completed all of the questionnaires at T1, completed questionnaires on psychological distress and maladaptive beliefs at T2, and completed the NSSI list at T3. Correlation analysis, structural equation modeling (SEM), and a bootstrap procedure were used to test our expectations., Results: Correlation analysis indicated that cyberbullying victimization, maladaptive beliefs, psychological distress, and NSSI were significantly and positively correlated with each other. The results of mediation analysis revealed that early cyberbullying victimization (T1) had a direct association with adolescents' subsequent NSSI (T3), and early cyberbullying victimization (T1) indirectly predicted adolescents' subsequent NSSI (T3) via the parallel and sequential mediating effects of maladaptive beliefs (T2) and psychological distress (T2)., Conclusions: Victims of cyberbullying are often prone to engaging in NSSI. Interventions that target students with NSSI should focus on intervening in their maladaptive beliefs and psychological distress following cyberbullying victimization., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Understanding of nonsuicidal self-injury relies almost exclusively on adolescent and emerging adult samples. We investigated the prevalence of lifetime and past-year nonsuicidal self-injury among New Zealanders aged 16-75 years and above, before evaluating if established associations between nonsuicidal self-injury, and demographic and psychological characteristics generalise to adults., Method: New Zealand adults ( n = 4906; median age 55-59 years; 55.5% female) completed a cross-sectional survey assessing lifetime and past-year nonsuicidal self-injury, psychological distress, self-esteem, emotion dysregulation, and social desirability susceptibility., Results: Nonsuicidal self-injury was common among adults; 25.6% participants reported ever self-injuring and 10.7% had done so at least once in the past year. Women and younger participants were more likely to report lifetime self-injury. Although younger participants were also more likely to report past-year self-injury than older participants, this age effect was attenuated for men ( b = -0.09) compared to women ( b = -0.18). Self-esteem (odds ratios 0.74, 0.74), psychological distress (odds ratios 1.09, 1.16), emotion dysregulation (odds ratios 2.05, 1.88), and desire to manage others' impressions of oneself (odds ratios 0.88, 0.85) were uniquely associated with both lifetime and past-year nonsuicidal self-injury, respectively, and these effects were not moderated by age., Conclusion: Although self-injury was most common among emerging adults, adults of all ages reported self-injuring. Individuals with a greater desire to manage how others perceive them appeared to underreport their nonsuicidal self-injury. While men were less likely than women to self-injure, they may also be more likely to continue self-injuring over adulthood, suggesting that the developmental factors which drive self-injury cessation among adults differ for men and women., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Non-suicidal self-injury (NSSI) among adolescents represents an alarming public health concern worldwide. Both family function and family socioeconomic status (SES) were found to play important roles in adolescent NSSI engagement. However, the effects of family function on NSSI among adolescents in different family SES are not well evidenced., Aims: This study aimed to explore how family functions (adaptation, partnership, growth, affection, and resolve) affect NSSI among adolescents in different family SES levels., Methods: Data used in this study was derived from the Students' Mental Health Network Project (SMHN), a survey conducted among 8,872 pairs of adolescent-caregivers in a city in central China. Socio-demographic characteristics, family function, NSSI, adverse life events, and depressive symptoms were measured among adolescents. Family SES were generated from caregivers self-reported information using principal component analysis. Chi-square test and multivariate binary logistic regression analyses were adopted to analyze the effects of family function on NSSI., Results: It revealed that 10.2% of adolescents reported engaging in NSSI in the past 12 months. Poor family function and high family SES were positively associated with NSSI. Partnership, both adaptation and affection, resolve were NSSI-protective factors for adolescents in low, middle, high family SES, respectively., Conclusions: Efforts to address NSSI should acknowledge the association between family function and NSSI among adolescents in different family SES levels.

Objective: To describe and compare contacts regarding self-injurious thoughts and behaviours to other contacts to emergency primary care., Design: Observational study., Setting: A sentinel network of seven emergency primary care centres throughout Norway., Subjects: Initial contacts regarding patients 10 years and older during 12 consecutive months (11/2021-10/2022)., Main Outcome Measures: Contacts due to self-injurious thoughts and behaviours., Results: Self-injurious thoughts and behaviours were the reason for contact for 0.6% ( n  = 478) of initial contacts for patients aged 10 years or older ( n  = 77 344). When compared to other contacts, self-injurious thoughts and behaviours were associated with female gender, younger age, occurrence during evening and nighttime, higher urgency, and more physician consultations and call-outs. Of contacts about self-injurious thoughts and behaviours, 58.2% were regarding thoughts and 41.8% about behaviours, and in 75.0% a history of similar contacts was recorded. Contacts regarding thoughts often concerned threats (30.6%) and were more often handled by telephone advice than contacts regarding behaviours. Contacts regarding behaviours with suicidal intent were associated with higher urgency and more physician call-outs than contacts regarding non-suicidal behaviours., Conclusion: Self-injurious thoughts and behaviours are rare reasons for contact to emergency primary care but are assessed as more urgent than other contact reasons and trigger more extensive medical help. Many of the patients are known to the service through a history of similar contacts., Implications: The infrequency and severity of these encounters might necessitate training, decision support and procedures to compensate for the health care personnel's limited exposure.

Two emotion regulation (ER) networks, the amygdala and ventral striatum (VS) circuits underpin defensive and reward processes related to non-suicidal self-injury (NSSI). Youth who engaged in non-suicidal self-injury behavior (NSSIB) and healthy controls either watched images passively (passive condition) or increased their positive affect during positive/neutral images and decreased their negative affect during negative and self-harm images (regulate condition) in the scanner. NSSI youth showed higher amygdala to precuneus and inferior parietal lobe (IPL) connectivity while regulating emotions during self-harm images, a pattern which was associated with higher self-injury frequency. NSSI youth showed higher VS connectivity to the fusiform gyrus and parahippocampus while regulating emotions elicited by self-harm and positive images, which was in turn linked to higher self-harm frequency and relief after NSSI. Higher amygdala-precuneus and IPL connectivity in NSSI youth suggest greater self-identification with, or difficulty regulating negative affect elicited by, self-injury images. High VS-fusiform gyrus and parahippocampus connectivity during positive and self-harm images implies reward anomalies and/or greater effort to regulate positive affect. VS circuit's' links to relief and NSSIB frequency suggest VS reward-based learning as biomarker of NSSIB endurance. We discovered ER mechanisms in adolescents with NSSIB and promising targets for effective NSSIB treatment., Competing Interests: Declaration of competing interest The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results., (Copyright © 2024. Published by Elsevier B.V.)

Purpose: Suicide and non-suicidal self-injury (NSSI) are preventable concerns in young people. Suicidal ideation (SI), suicidal plans (SP) and suicidal attempt (SA) are closely related to death. Sleep problems are known risk factors for suicide and NSSI. This study aimed to explore the relationship between sleep, suicidality and NSSI., Methods: Participants were 3,828 middle school and college students aged 11-23 years from urban and rural areas of Henan Province. Sleep, suicidal phenomena and NSSI were assessed by applying self-reported questionnaires. Chi-squared tests were utilized to demonstrate the demographic data and sleep variables. The correlation between sleep, suicidality and NSSI were explored by using binary logistic regression, while adjusting socio-demographic characteristics with multivariate models., Results: Sleep variables except mid-sleep time were related to suicidal phenomena (P < 0.05). Greater social jet lag (SJL) [≥ 2 h (h)] was associated with increased risk of SI [Odds ratios (OR) = 1.72, 95% confidence intervals (CI):1.40-2.11], SP (OR = 2.10, 95%CI:1.59-2.79) and SA (OR = 1.50, 95%CI:1.00-2.26). Non-only child participants with SJL (≥ 2 h) had significantly increased odds of SI (OR = 1.75, 95%CI: 1.41-2.18) and SP (OR = 2.25, 95%CI: 1.66-3.05). Eveningness chronotype had the strongest correlation with SI (OR = 3.87, 95%CI:2.78-5.38), SP (OR = 4.72, 95%CI:2.97-7.50), SA (OR = 6.69, 95%CI:3.08-14.52) and NSSI (OR = 1.39, 95%CI:1.02-1.90)., Conclusion: Overlong or short sleep duration, SJL, eveningness chronotype and other sleep abnormalities (e.g., daytime dysfunction, low sleep efficiency) were associated with a higher prevalence of SI, SP and SA. Additionally, eveningness was significantly correlated with NSSI among young people. These findings suggested the importance of assessing and intervening in sleep habits to prevent suicide and NSSI in young people., Competing Interests: Declarations. Competing interest: All authors declare they have no competing financial interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Many people who engage in non-suicidal self-injury (NSSI) do not access support from health services, and evidence regarding the effectiveness of interventions is mixed. Despite this, NSSI prevalence rates decrease from adolescence into adulthood. Little is known about what helps alleviate difficulties with NSSI beyond psychological or medical intervention. This study sought to understand factors influencing naturalistic improvements in NSSI., Methods: Semi-structured interviews were conducted over video call with 16 participants who believed their difficulties with NSSI had improved due to factors not attributed to psychological or medical intervention. Interviews were audio recorded and transcribed verbatim for analysis., Results: A reflexive thematic analysis revealed four main themes. Increased insight into NSSI experiences promoted self-compassion and self-acceptance and enabled participants to reflect on the conflicting role of NSSI. Safe and supportive relationships helped alleviate loneliness, and developing alternative coping strategies enhanced feelings of control over self-injury. Creating a life guided by personal values promoted independence, choice, and self-esteem., Conclusions: The findings of the study highlight several internal and external naturalistic processes deemed meaningful in improving difficulties with NSSI. Clinical implications include the importance of developing and embedding these approaches within services and interventions to improve outcomes for individuals who self-injure while promoting a person-centred approach., (© 2024 The Author(s). Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society.)

Background: Craniocerebral self-inflicted gunshot wounds (SIGSW) are fatal in 90% of individuals, usually before reaching a hospital setting. We report a unique SIGSW survivor's residual neurologic deficits, imaging, neuropsychiatric findings, and improvement in psychosis., Case Presentation: The patient is a 32-year-old right-handed Caucasian male with a medical history of paranoid schizophrenia who attempted suicide by SIGSW. After transport to the Emergency Department (ED), an emergent craniotomy was required for wound debridement, hematoma evacuation, and craniofacial reconstruction. He transitioned to rehabilitation and continued to improve. We evaluated him seven years later when he returned to the ED for breakthrough seizure activity. Detailed neurologic, neurobehavioral, and psychiatric evaluations were accomplished, including the Frontal Assessment Battery (FAB). His deficits included distractibility, impaired digit span, poor confrontation and generative naming, effortful spontaneous speech, and transcortical motor aphasia with frequent semantic paraphasic errors. Language comprehension was intact, and he answered simple questions with short responses. Psychiatric interviews of the patient and his mother revealed resolution of auditory hallucinations and paranoid delusions following recovery from the SIGSW., Discussion: Our testing revealed widespread deficits on the FAB. Neurobehavioral and language assessments suggested frontal lobe dysfunction, including transcortical motor aphasia. His psychiatric interview findings revealed similarity to findings report in the 1940s-50s after frontal leukotomy initially proposed by Egas Moniz., Conclusion: Frontal lobe damage produced cognitive and neurobehavioral impairments and improved neuropsychiatric symptoms such as hallucinations and psychosis in a SIGSW survivor., Competing Interests: Declarations. Ethics approval and consent to participate: Approval for participation in this manuscript was provided by the patient and his primary caregiver. Informed consent was obtained from the patient and his legal guardian. Consent for publication: Informed consent for publication was obtained prior to the creation of this manuscript. Informed consent was obtained from the patient and his legal guardian. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Nonsuicidal self-injury (NSSI) is a major public health problem leading to psychological problems in adolescents and young adults, similar to disorders such as depression and anxiety., Objective: The aims of this study were to investigate (1) the interaction between BMI and socioenvironmental factors (including chronotype and mental health) that contribute to NSSI, and (2) whether self-esteem plays a mediating role in this association., Methods: From May to June 2022, the multistage cluster sampling method was used to sample college students in four grades, including freshmen and seniors. The baseline participants were followed up 6 months later, excluding those who did not qualify, and the participants included 1772 college students. Socioenvironmental factors (chronotype/mental health), self-esteem, and NSSI were measured using a questionnaire. Multivariate linear regression models and chi-square analysis were used to evaluate the linear relationship between BMI, socioenvironmental factors, and self-esteem and the NSSI status. We use a process approach (mediation-moderation analysis) to explore the complex relationships between these variables., Results: The mean age of the participants was 20.53 (SD 1.65) years at baseline. A significant association was revealed, suggesting that a high BMI (β=.056, 95% CI 0.008-0.086, P=.018) was associated with a higher NSSI. There was also an interaction among BMI, socioenvironmental factors, and NSSI. Socioenvironmental factors played both moderating and mediating roles in the relationship between BMI and NSSI, whereas self-esteem only played a mediating role., Conclusions: Paying attention to factors such as overweight and obesity is important for early BMI control to identify other potential risk factors for NSSI and to evaluate how self-esteem can be improved considering multiple perspectives to improve the effect of BMI on NSSI in adolescents., (© Yi Zhang, Ruixue Ying, Wan Lu, Xuemeng Liu, Keyan Hu, Qing Feng, Zixiang Yu, Zhen Wang, Fangting Lu, Yahu Miao, Nanzhen Ma, Fangbiao Tao, Tian Jiang, Qiu Zhang. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Background: Suicide is a major behavioral issue among children and adolescents, and family functioning potentially influencing its occurrence. Furthermore, positive behavior recognition, as a key component of positive youth development, may act as a mediating factor in the relationship between family functioning and suicide. Non-suicidal self-injury (NSSI) often co-occurs with suicide and may also mediate the impact of family functioning on suicide. Therefore, the aim of this study is to examine the role of family functioning in child and adolescent suicide, with positive behavior recognition and NSSI serving as sequential mediating factors., Methods: The participants in this study were recruited from the Chengdu Positive Child Development (CPCD) cohort study. The analysis was based on the second round of cross-sectional data from the CPCD cohort. They were required to complete questionnaires that included measures of family functioning, suicide, positive behavior recognition, and NSSI. SPSS 26.0 and Mplus 8.3 were used for descriptive statistical analysis, correlation analysis and mediation effect analysis., Results: A total of 8,124 participants completed the questionnaires, with an average age of 11.00 ± 2.18 years. The sample comprised 4,195 male and 3,929 female participants. The findings indicate that 17.93% of children and adolescents reported suicide thoughts, 10.06% had formulated suicide plans, and 8.64% had attempted suicide. Poor family functioning shows a significant positive correlation with suicide ( r  = 0.322, p  < 0.01). The multiple mediation effect of positive behavior recognition and NSSI in the association between family functioning and suicide was statistically significant ( β  = 0.034, 95% CI = 0.027, 0.042)., Conclusion: This study found that poor family functioning is a risk factor for suicide in children and adolescents, with positive behavior recognition and non-suicidal self-injury acting as sequential mediating factors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Li, Liu, Hu, Huang, Li, Li, Shi, Yang, Peng, Ma, Wan and Peng.)

Background: Although theory and research implicate self-criticism as a risk factor for non-suicidal self-injury (NSSI), the nature of this association in daily life remains unclear. This study used ecological momentary assessment (EMA) to address whether (1) trait and state self-criticism elevate the risk of NSSI, (2) state self-criticism predicts NSSI behavior in real-time via increased NSSI urge intensity, and (3) the risk pattern extends to disordered eating (DE; binge eating, purging, restrictive eating)., Methods: A total of 125 treatment-seeking individuals who self-injure (87.20% female; M age  = 22.98, SD = 5.32) completed measures of trait self-criticism at intake, followed by six daily assessments for 28 days (15,098 assessments; median compliance = 78.6%) measuring self-critical thoughts, NSSI, and DE. Multilevel vector autoregressive models were constructed within a dynamic structural equation modeling framework., Results: Patients who reported higher mean state self-critical thoughts experienced more intense NSSI urges and an increased risk for NSSI behavior during the 28-day EMA period. Higher-than-usual self-critical thoughts predicted NSSI urge intensity and NSSI behavior within the following 2 h. NSSI urge intensity partially mediated the effect of self-critical thoughts on NSSI behavior. Trait self-criticism did not predict comorbid DE, but mean state self-critical thoughts were associated with binge eating and restrictive eating. The within-person risk pattern of self-criticism generally extended to DE, with full mediation via DE urges for purging and restrictive eating, but not binge eating., Conclusions: Self-criticism is a real-time predictor of NSSI and comorbid DE. These findings underscore the relevance of monitoring self-criticism outside the therapy room, as it may be an important treatment target., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The purpose of this study was to develop a digital self-harm scale suitable for Chinese adolescents, and to test its reliability and validity., Methods: Through semi-structured interview, literature analysis and expert evaluation, the initial questionnaire was developed, and 1651 students from three middle schools in Jilin Province were selected for questionnaire survey. Item analysis and exploratory factor analysis were carried out, and 843 students were selected for confirmatory factor analysis, convergent validity, discrimination validity, criterion validity, content consistency reliability and retest reliability., Results: The results showed that the digital self-harm scale consisted of eight items divided into two factors, namely External self image harm and Inner self emotional harm. And 73.47% of the total variance was explained. The two-factor structure model fitted well ( 2 χ/df = 4.2, CFI = 0.994, TLI = 0.989, SRMR = 0.01, RMSEA = 0.062). The total score and each factor score of the digital self-harm scale were negatively correlated with sleep duration, and positively correlated with other criteria. The Cronbach α coefficient of the total scale and each factor was 0.938-0.965, and the retest reliability was 0.983-0.991., Limitations: The Inner self emotional harm dimension has few questions, the relationship and mechanism between digital self-harm and non-suicidal self-injury is not deep enough., Conclusions: The digital self-harm scale developed in this study has good validity and reliability, and can be used as a measurement tool to assess the digital self-harm of Chinese adolescents., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval for this study was obtained from the ethics committee of the First Affiliated Hospital of Jilin University (approval code:22k071-001). A written informed consent was considered obtained from each participant when submitting the online form. All methods were performed in accordance with the relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The aim of this study was to assess emotional dysregulation (ED) and sexual risk behavior (SRB) in borderline personality disorder (BPD) and to investigate the relationship between ED, SRB and other clinical variables. Sixty-one women with BPD and 76 healthy controls (HCs) completed: SRB Scale, DERS, Inventory of Statements About Self-Injury, SUPPS-P, HADS, Mental Pain Scale, and BPD Checklist. The BPD group exhibited higher levels of ED, SRB, psychological pain, anxiety, depression, and impulsivity than the HCs. In the BPD group, significant correlations were found between ED, SRB, and psychological pain, impulsivity, and specific dimensions of nonsuicidal self-injury (NSSI). To identify predictors of SRB, stepwise multiple regression analysis was used. The BPD model included five significant predictors accounting for 65% variability: number of sexual partners and age of sexual initiation, NSSI, impulsivity, and ED - lack of emotional clarity, while in HCs, it was influenced by alcohol misuse.

Previous research has documented that family-related supportive factors (e.g., family resilience) can protect adolescents from risky behaviors. However, the data regarding the potential psychological mechanism linking family resilience and non-suicidal self-injury (NSSI) remain scarce. This study aimed to explore the possible serial mediational roles of mindfulness and individual resilience in the relationship between family resilience and NSSI. A sample including 548 Chinese adolescents (M age  = 16.10, SD = 1.61; 50.9 % male) with a six-month interval and two waves (Time 1, T1 - September 25, 2023 - October 13, 2023; Time 2, T2 - March 9, 2024 - March 22, 2024) of follow-up was used in the present study. Results showed that, within the examined model, mindfulness at T2 mediated the relation between family resilience at T1 and NSSI at T2; individual resilience at T2 mediated the association between family resilience at T1 and NSSI at T2; and the relationship between family resilience at T1 and NSSI at T2 was fully serially mediated by mindfulness and individual resilience at T2. The findings suggest that family resilience may reduce the likelihood of NSSI by enhancing adolescents' mindfulness and individual resilience. Future interventions aimed at reducing NSSI may benefit from incorporating strategies to strengthen family resilience, promote mindfulness practices, and enhance individual resilience in adolescents., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Introduction: Sexual and gender minority (SGM) individuals report a higher prevalence rate of nonsuicidal self-injury (NSSI) compared to their cisgender heterosexual peers. Minority stress theory posits that the unique stressors experienced by those with a minoritized sexual orientation and/or gender identity increase the risk of negative health outcomes. As such, SGM stress may be a significant risk factor for NSSI and may help explain the disparate prevalence rates in the community., Method: Thus, a meta-analysis was conducted to assess the relationship between SGM stress and NSSI (k = 42; N = 253,686)., Results: Broadly, SGM stress was significantly positively related to NSSI engagement (r = 0.15). While this effect size is small in absolute size, it is comparable to other evidence-based risk factors for NSSI, such as impulsivity. Contrary to our hypothesis, the number of items used to assess NSSI engagement did not significantly moderate the relationship (b = -0.001). Exploratory analyses found no significant difference between proximal and distal SGM stressors (b = 0.07), sexual minority stress and gender minority stress (b = 0.03), nor assessment of lifetime compared to past year NSSI engagement (b = 0.08)., Conclusion: Overall, the results of this meta-analysis support that SGM stress is a significant risk factor for NSSI and should be integrated into interventions for NSSI., (© 2025 American Association of Suicidology.)

Self-injurious behaviors (SIB) commonly occur in autism spectrum disorder (ASD) and span diverse topographies of self-inflicted behaviors ranging from head banging to hitting oneself against hard objects. Despite the high rates of SIB in autistic individuals, relatively little research has focused on psychological factors associated with the development and maintenance of SIB in individuals with autism and moderate-profound intellectual disability (ID). This commentary synthesizes existing literature on SIB and highlights the need for more research focused on psychological correlates and mechanisms in autistic individuals with moderate-profound ID. We highlight the key role of difficulties in emotion regulation (ER) and co-occurring internalizing symptoms in the manifestation of self-harm behaviors in clinical samples and autism. Furthermore, this commentary proposes a framework for understanding the interplay between poor ER and internalizing symptoms in the development and maintenance of SIB in autistic individuals with moderate-profound ID. Specifically, we explore the emergence of SIB in the context of precipitating cues that trigger strong emotions, ER processes and strategy deployment, and co-occurring internalizing symptoms. Future directions and implications for longitudinal research, measurement development, and clinical treatments are discussed., (© 2024 International Society for Autism Research and Wiley Periodicals LLC.)

Introduction: Nonsuicidal self-injury (NSSI) often helps regulate affect, yet there is conflicting research on the immediate affective outcomes of pain and NSSI. People also engage in NSSI for intrapersonal and interpersonal reasons. It is unclear whether affective shifts post-pain task differentiate individuals with and without NSSI histories, and are influenced by interpersonal or intrapersonal motives for NSSI. The present study examined the effect of pain on affective shifts, and to investigate motives for NSSI as moderators., Methods: Participants were 134 women (n = 77 with recent/recurrent NSSI), that completed measures of NSSI and reported their positive and negative affect pre- and post-pain-task., Results: Our findings suggest that participants without a history of NSSI reported greater decreases in positive affect pre-to-post task. NSSI history did not predict fluctuations in negative affect after controlling for stress. Namely, at low levels of stress, participants reported greater decreases in negative affect following the pain task. Finally, interpersonal motives for NSSI predicted increased positive affect following the endurance of pain., Conclusion: Findings suggest that affect changes in response to pain may not be differentially associated with NSSI history; however, among people with a history of NSSI, interpersonal motives may predict changes in positive affect following a pain task., (© 2025 American Association of Suicidology.)

Objective: The study aims to investigate the efficacy of sertraline medication plus dialectical behavior therapy (DBT) in reducing nonsuicidal self-injury (NSSI) behavior and depression among adolescents., Methods: Participants were 100 adolescents with depression and NSSI behaviors, 50 of whom received sertraline medication plus DBT and 50 of whom received sertraline medication plus cognitive behavioral therapy (CBT) for 12 weeks., Results: During 6 months post intervention, 26 (57.8%) participants did not report having engaged in any form of NSSI in the sertraline + DBT group and 15 (32.6%) in the sertraline + CBT group, showing significant difference. The sertraline + DBT group and the sertraline + CBT group exhibited significant difference regarding the proportions of cutting skin and biting self. The scores of anxiety, depression, aggression against self in four modified overt aggression scale categories, and Personal and Social Performance were notably lower in the sertraline + DBT group than those in the sertraline + CBT group at 6 months post intervention., Conclusion: Sertraline medication plus DBT could decrease NSSI episodes and improve symptoms of anxiety and depression for adolescents, and these changes were comparable to those of CBT. More importantly, DBT was demonstrated better clinical improvements at 6-month follow-up., (© 2024 The Author(s). Suicide and Life‐Threatening Behavior published by Wiley Periodicals LLC on behalf of American Association of Suicidology.)

Background: Childhood adversity is robustly associated with mental ill-health. Yet questions remain about how different ways of conceptualising adversity relate to psychiatric diagnoses and service activity. This research aims to examine associations between typological and cumulative conceptualisations of adversity, and psychiatric diagnosis and service activity., Methods: We analysed risk assessment data from 21,072 young people attending mental health services in South London. These assessments include items relating to maltreatment, parental mental health difficulties, substance misuse, self-harm, and violent behaviour. Using latent class analysis, we identified the following risk typologies: 'Maltreatment and externalising behaviours' (n = 971, 4·6 %), 'Maltreatment but low risk to self and others' (n = 2526, 12·0 %), 'Anti-social behaviour' (n = 2669, 12·7 %), 'Inadequate caregiver supervision and risk to self and others' (n = 907, 4·3 %), 'Risk to self but not to others' (n = 1725, 8·2 %), and 'Mental health needs but low risk to self and others' (n = 12,274, 58·2 %). Two cumulative risk models were created: 1) all risk items 2) Adverse Childhood Experiences-related cumulative risk (ACES-CR). Controlling for gender, ethnicity, age, and deprivation, we examined associations between risk typologies, cumulative risk, and the following outcomes: 1) psychiatric diagnosis 2) face-to-face appointments 3) missed appointments 4) referral to social services., Outcomes: Risk in its various conceptualisations was consistently and robustly associated with conduct disorder. Risk also tended to be associated with more face-to-face appointments, missed appointments, and referral to social services. Associations between individual risk typologies and psychiatric diagnosis and service activity are discussed., Interpretation: Our findings suggest that typological and cumulative approaches to risk and adversity can produce unique insights about diagnostic practices and service activity. This work provides further evidence for the contribution of contextual factors to mental ill-health and further work is required to explore the longer-term trajectories of these young people., Competing Interests: Declaration of competing interest No conflicts to declare., (Crown Copyright © 2025. Published by Elsevier Inc. All rights reserved.)

Introduction: Risk factors for suicide after parental suicide may include points in the lifecourse when reminders of the deceased trigger grief resurgence. We hypothesized that risk of suicide attempt and suicide is elevated among suicide-bereaved offspring on reaching the age at which a parent died by suicide., Methods: We conducted a self-controlled case series (SCCS) study using national register data on all individuals bereaved by parental suicide living in Denmark from 1980 to 2016. We compared relative incidence of our combined outcome (any secondary-care episode of self-harm or suicide) during the exposure period (2 years centred on the birthday representing age correspondence) and the 15-year unexposed periods either side. We repeated these models for offspring bereaved by parental non-suicide death as an indirect comparison., Results: Risk of self-harm or suicide was elevated on reaching the age at parental suicide (n = 188; IRR adj : 2.02, 95% CI: 1.21-3.38) relative to flanking periods, but not at parental non-suicide death (n = 734; IRR adj : 0.76; 95% CI: 0.39-1.50)., Conclusions: Reaching the age at which a parent died by suicide appears to represent a vulnerable period for suicidality, countering public perceptions that time heals linearly. This indicates a need for support in the lead up to age correspondence., (© 2024 The Author(s). Suicide and Life‐Threatening Behavior published by Wiley Periodicals LLC on behalf of American Association of Suicidology.)

Background: While prior research has suggested that experiencing bullying victimization increases the risk of self-harm, the exact role of intrapersonal emotion regulation and bullying peer norms in contributing to this association are not fully understood., Objective: This study examined the mediating effects of cognitive reappraisal and expressive suppression and the moderating effects of bullying descriptive and popularity norms on the association between bullying victimization and self-harm., Participants and Setting: A total of 3545 Chinese adolescents (52.4 % boys; Mage = 12.36 years; 90.9 % Han nationality) from 76 classes participated in the current study., Methods: Data were collected in two waves, spaced six months apart. Participants completed self-report questionnaires regarding bullying victimization, bullying perpetration, emotion regulation and self-harm. Peer nomination items were used to assess bullying perpetration and popularity., Results: The study found that bullying victimization was linked to an increase in self-harm six month later, both directly and indirectly, by enhancing the use of expressive suppression. The effects of expressive suppression as a mediator were notably stronger in environments with low bullying descriptive norms or high bullying popularity norms., Conclusions: These findings provide insights into the mechanisms by which bullying peer norms adversely affect emotion regulation and escalate self-harming behaviors among victimized adolescents. Effective bullying prevention and intervention strategies should focus not only on reducing bullying behaviors, but also on addressing maladaptive emotion regulation strategies such as expressive suppression. Additionally, fostering a classroom environment characterized by non-aggressive and prosocial norms is crucial for mitigating the negative outcomes associated with bullying., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Determining trauma as an act of Self-directed violence (SDV) or from high risk or unclear behaviours is challenging for trauma clinicians and may be affected by patient sex and mechanism of injury. The aim of this study was to examine the differences in characteristics and outcomes between those who have intentionally directed violence towards themselves with those of unclear intent, within a regional trauma system., Methods: Data was collected between January 2018 and December 2021 in patients who had been identified as a result of either self-directed violence (SDV) defined as any intentional act that can cause injury to one's self, including death or participated in high-risk behaviours, where the intent was unclear (UI). Differences between female and male patients presenting with SDV and unclear intent were explored., Results: Overall, 2760 patients were identified, with a median age of 39 years (IQR 28-54) and just over a quarter of females (28 %). Falls from height were the most common mechanism of injury in all groups. SDV was recorded in 45 % of patients, and previous mental health diagnoses were almost three times as prevalent in this group compared to those of unclear intent (SDV: 42 % vs UI: 13 %). In the sex-based analysis females were more likely than males to have a history of depression (49 % vs 31 %, p < 0.0001). There were few sex differences in the SDV group but women of unclear intent were older, with a quarter being aged 65 years or over (Females: 26 % vs. Males: 11 %, p < 0.0001). Females of unclear intent were also more likely to have sustained a high level fall (Females: 29 % vs. Males:11 %, p < 0.001)., Conclusion: Previous mental health co-morbidity was associated with self-directed violence in our cohort. Yet the determinants of intent for over half of the patients were unclear. Trauma clinicians should actively enquire regarding intent of injury and escalate to clinical psychology or psychiatry teams as indicated. Those with mental health comorbidities, previous depression and older women may all have an increased risk where intent is unclear and warrants further investigation. Understanding the predictors and characteristics of unclear intent and high-risk behaviours are key to implementation of public health strategies around prevention of self-directed violence and suicide., Competing Interests: Declaration of competing interest No declaration of interest for any author., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Introduction: High rates of suicidal ideation (SI), suicide attempts (SA), and repetitive nonsuicidal self-injury (NSSI) among some ethnoracially minoritized United States youth populations may be related to adverse childhood experiences (ACEs) with structural roots., Methods: Using the 2013-2019 Minnesota Student Surveys, we assessed associations of student-reported structural ACEs (parental incarceration, housing instability, food insecurity, and foster care involvement) with SI, SA, and repetitive NSSI within the past 12 months using multilevel logistic regression stratified by ethnoracial group (American Indian/Alaskan Native [AIAN], Hmong, other Asian, Black Latino, other Latino, Somali, other Black/African American [AA], Native Hawaiian/Pacific Islander [NHPI], and multiracial), and adjusted for sex, grade, ACEs experienced within one's household, mental health treatment, and perceived safety., Results: Structural ACEs were strongly associated with increasing SI, SA, and NSSI. At ≥2 structural ACEs, repetitive NSSI rates ranged from 7% to 29% (female), 8% to 20% (male); SA rates ranged from 13% to 35% (female), 10% to 22% (male); and SI rates ranged from 31% to 50% (female), 20% to 32% (male). Black Latino, NHPI, AIAN, and Black/AA students most often reported structural ACE exposures., Conclusion: Reducing structural ACEs may reduce SI, SA, and repetitive NSSI among ethnoracially minoritized youth populations. Disaggregating diverse youth groups revealed variations in these outcomes that remain hidden when subpopulations are aggregated., (© 2024 The Authors. Suicide and Life‐Threatening Behavior published by Wiley Periodicals LLC on behalf of American Association of Suicidology.)

Introduction: The COVID-19 pandemic has significantly affected adolescents' mental health, raising concerns about the potential increase in self-harming and suicidal behaviors (SIB). This study aimed to evaluate the pandemic's impact on SIB among adolescents and explore the effects of school closures and psychiatric vulnerabilities to inform future interventions., Methods: A systematic review and meta-analysis were conducted using PubMed, resulting in 420 studies, of which 36 studies (comprising 53 samples) met the inclusion criteria, encompassing 1,754,106 adolescents. Effect sizes were calculated using proportion effect size. Heterogeneity across studies was assessed using Q-statistics and I², while Egger's test was applied to evaluate publication bias. Differences between clinical and community samples, as well as the influence of psychiatric symptoms or disorders, were examined., Results: Clinical samples demonstrated higher rates of SIB compared to community samples, with adolescents having psychiatric symptoms or disorders being more vulnerable. Overall, the pandemic was associated with a decline in SIB rates compared to pre-pandemic levels. Suicidal ideation decreased by 4.14% in combined samples and by 7.13% in community samples. Self-harm rates fell by 5.38% and 6.62% in combined and community samples, respectively. In contrast, clinical samples showed a distinct trend, with suicidal ideation decreasing by 29.39%, while self-harm rates increased by 32.51% and suicide attempts rose by 22.41%., Conclusion: The COVID-19 pandemic's impact on adolescents' SIB varied significantly across population types and levels of psychiatric vulnerability. While general declines were observed, the pronounced increases in self-harm and suicide attempts among clinical samples highlight the need for tailored mental health interventions. Addressing these disparities is essential for future mental health strategies and crisis preparedness., (© 2025 American Association of Suicidology.)

Objective: Dissociative disorders are common in psychiatric patients and severely impact patients' lives. They are, however, underdiagnosed, thus preventing patients from accessing timely and adequate therapy. Identifying how patients with dissociative disorders relate to themselves could improve diagnostics. However, this question has not been explored in detail. The aim of the study was to gain insights into how people with complex dissociative disorders relate to themselves., Method: We conducted semistructured qualitative interviews with ten women diagnosed with complex dissociative disorders who had previously completed trauma-focused therapy. Data were analyzed through reflexive thematic analysis., Results: Participants described their behavior toward themselves before the start of the therapy as "autopilot-functional" and "self-destructive." The "autopilot functionality" was characterized by being outward-oriented and ignoring one's own needs. Hence, participants only appeared to be functional. "Self-destructive behavior" was described as a spectrum of various destructive behaviors (e.g., eating disorders, self-harm, excessive exercise, and substance abuse) that participants perceived as a cohesive complex. The participants illustrated that both behaviors were driven by a lack of self-empathy and connected to suppression and poor perception of bodily stimuli., Conclusions: "Autopilot functionality" seems to be a hallmark in patients with complex dissociative disorders. With patients hiding their self-destructive behavior, health personnel may misjudge the severity of these patients' mental illness. Neither "autopilot functionality" nor "self-destructive behavior" should be judged (neither negatively nor positively), but one should understand both as a coping mechanism for trauma-related disorders. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction: Non-suicidal self-injury (NSSI) is a growing public health concern among young adults in both clinical and non-clinical settings. Despite evidence linking NSSI to alterations in learning from reward and punishment, this area remains understudied, especially in non-clinical populations without borderline personality disorder (BPD)., Methods: We employed a modified version of the Probabilistic Stimulus Selection (PSS) task in two groups of young adults with recurrent NSSI, with (NSSI+BPD) and without BPD (NSSI), and an additional group of healthy controls (HC). While undergoing functional magnetic resonance imaging (fMRI), participants were asked to choose between pairs of stimuli with different reward probabilities. In the training phase, they received probabilistic feedback and learned to identify the most rewarding option within fixed pairs. In the test phase, these learned stimuli were recombined into novel pairs, where participants' accuracy in selecting the most rewarding and avoiding the most punishing options reflected their ability to learn from reward and punishment, respectively., Results: Compared to HC, participants in the NSSI and NSSI+BPD groups were less accurate at avoiding the most punishing options than at choosing the most rewarding options, and showed reduced activity in the nucleus accumbens (NAcc) during punishment avoidance relative to reward selection., Limitations: The modest sample size, descriptive rather than modeling approach, and absence of ecological momentary assessments may limit the results., Conclusion: Findings suggest that reduced activation of the NAcc when avoiding loss may underlie difficulties in learning to avoid punishment in young adults with NSSI, regardless of the presence of BPD., Competing Interests: Declaration of competing interest All authors declare that they have no conflict of interest with respect to their authorship or the publication of this article., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The study aims to explore the effect of family function on non-suicidal self-injury (NSSI) among Chinese urban adolescents with and without parental migration. Between April 21st to May 12th, 2021, adolescents were recruited from Shenzhen city of Guangdong province, China (n = 124,357). Of all the participants, 22,855 (18.4%) were left-behind children (LBC). Family function, NSSI, depression, and socio-demographic characteristics were assessed using a series of self-reported questionnaires. Urban LBC had a higher NSSI frequency, while a lower level of family function than non-LBC. After controlling for confounders, parental migration was significantly associated with NSSI, and family dysfunction was a robust risk factor for NSSI as well. The protective effect of family function on NSSI of LBC was stronger than non-LBC. This implies that children with higher levels of family function tend to exhibit a lower frequency of NSSI, especially in those with parental migration. In practice, adolescents' NSSI prevention and intervention strategies should focus on improving family function., Competing Interests: Declarations. Ethical Approval: The investigation was carried out in accordance with the Helsinki Declaration as revised in 1989 and approved by the Ethics Committees of South China Normal University (SCNU-PSY-2021-094). Consent to Participate Informed consent was obtained from legal guardians and informed assent was obtained from all individual participants included in the study. Competing interests: The authors have no competing interests., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The World Health Organisation (WHO) reports that 700 000 people die every year by suicide. An Arts Health education program was co-designed for pre-registration nursing students to conduct a risk assessment for self-harm and suicide with empathy and compassion. Nursing researchers collaborated with clinicians, a theatre professional and filmmakers to develop an engaging, authentic and evidence-based short film to be embedded in a nursing program. The education program was evaluated by second-year pre-registration students in a multiple-methods study. Quantitative and qualitative data were collected concurrently. Quantitative data were collected using surveys and revealed that the debriefing session which followed the education program fostered reflection, peer learning and critical thinking. To explore the students' perceptions of the short film, qualitative data were collected using five open-ended questions. This data was analysed to identify common themes from the qualitative data on student engagement with the short film. Four themes emerged: (1) The importance of asking risk assessment questions; (2) Making connections; (3) Developing empathy; and (4) Wanting to learn more. This Arts Health education program deepened the student's understanding of the importance of risk assessment and provided an opportunity to practice these skills in a safe environment. Conducting a risk assessment to identify the potential for self-harm and suicide is an important clinical skill that should be mastered by all nurses. It requires communication skills that show empathy and compassion so that the person develops trust to disclose their thoughts of harm., (© 2025 John Wiley & Sons Australia, Ltd.)

Objective: To understand the clinical characteristics and risk factors of early-onset schizophrenia in children with self-injurious suicide behavior., Methods: From March 2021 to December 2021, the clinical information of 77 inpatients with demography characteristics, family characteristics, and diseases which met the ICD-10 diagnostic criteria for "schizophrenia" in the pediatric wards of Shanghai Mental Health Center was retrospectively collected. According to whether or not there was self-injurious suicide behavior, they were divided into the self-harm and suicidal behavior group (self-harm and suicidal behavior - S) and the non-self-injurious suicide group (NS); inter-group comparison and regression analysis was performed between the two groups., Result: There were 51 cases (66.2%) of early-onset childhood schizophrenia patients with self-injurious suicidal behavior, verbal auditory hallucinations (94.12%) and delusion of reference (92.16%) being the main psychological symptoms. Compared with early-onset schizophrenia patients without self-injurious suicidal behavior, early-onset schizophrenia patients with self-injurious suicidal behavior had a higher incidence of delusion of reference (t=3.184, P=0.002) and command auditory hallucinations (t=2.256, P=0.027). The Eysenck Personality Questionnaire showed that the score of neuroticism was higher (F=4.139, P=0.001); the level of free tetraiodothyronine (FT4) was lower (t=-4.436, P<0.001); and logistic regression analysis showed that gender (P=0.036, OR=14.863), FT4 (P=0.011, OR=0.607) and neuroticism score (P=0.035, OR=1.073) were related to the occurrence of self-injurious suicide in children with early-onset schizophrenia., Conclusion: Early-onset schizophrenia patients with self-injurious and suicidal behavior have typical psychiatric symptoms, accompanied by some characteristics associated with emotional instability. Females with low levels of FT4 and neuroticism have risk factors for suicide with self-injury in early-onset schizophrenia., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: Non-suicidal self-injury (NSSI) is a serious public health problem that can lead to adverse effects such as cognitive impairment, poor interpersonal relationships and violent crime. The progress of preventing and treating NSSI in adolescents depends on other changeable risk factors, such as negative mood, sleep, and diet habits. However, the risk factors for adolescent NSSI remain unclear. Therefore, this study explores the key factors influencing adolescents' NSSI behavior through the use of network analysis., Methods: The study recruited 4040 middle school students aged 12-18 years old. From November 1st, 2023 to January 1st, 2024, paper questionnaires were utilized to investigate the participants' basic conditions, negative mood, NSSI, sleep conditions, and diet habits. Network analysis was used to explore the interrelationship among risk factors and discover the core factor., Results: In the network structure of adolescents with NSSI behavior, the most correlated nodes were negative emotions (CDI2) and low self-esteem (CDI3). Compared with adolescents without NSSI behavior, adolescents with NSSI behavior showed prominent anxiety symptoms related to injury avoidance (MASC1) and social anxiety (MASC2). Anhedonia (CDI1) was both the central node and the bridge node of the network., Limitation: The cross-sectional design of this study couldn't clarify the causal inference between independent variables and results., Conclusion: Anhedonia is the key factor affecting adolescents' emotion regulation. Furthermore, we hypothesize that adolescent NSSI is an emotional disorder, and anhedonia plays an important role in preventing and intervening in adolescents' NSSI behavior., Competing Interests: Declaration of competing interest The author states that the study is conducted without any business or financial relationship and can be interpreted as a potential conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: People who identify as sexual minorities (SM) report higher rates of nonsuicidal self-injury (NSSI) than heterosexual individuals. One explanatory factor that may be important in this relation is self-defective beliefs. The present study examined the role of self-defective beliefs in the link between sexual orientation and NSSI., Method: Participants were college-aged women (n = 145) with (n = 84) and without (n = 61) recent, recurrent NSSI, completed measures of NSSI and self-defective beliefs. Participants were recruited from a large college and surrounding area in the northeastern U.S., Results: suggest that SM participants were more likely to report a history of NSSI, frequent and versatile NSSI, and greater self-defective beliefs compared to heterosexual participants, but not more likely to report medically severe NSSI. Results from cross-sectional mediation analyses revealed that self-defective beliefs mediated the relation between SM identity and lifetime NSSI history and partially mediated the relations for NSSI medical severity and versatility, but not NSSI frequency., Conclusions: Taken together, our findings suggest that self-defective beliefs are a salient cognitive concern associated with indicators of NSSI severity in college-aged SM women. Additional research is needed to determine whether these findings replicate in SM men, transgender, and gender diverse populations., (© 2025 American Association of Suicidology.)

While the connection between risk factors and suicidality (suicide attempts and ideation) and physical self-harm is well established, the preventive roles of social bonding and dietary patterns remain underexplored. This study, based on the 2021 National Ungdata Surveys in Norway among middle and high school students ( N  = 15,430), can provide novel and context-specific insights into comparable environments. The results indicated a 5% suicide attempt rate, 18.3% prevalence of physical self-harm, and 26.7% suicidal ideation in the sample. The prevalence was higher among girls, students with low socioeconomic status, middle schoolers, and non-religious individuals. Logistic regression models for suicide attempts showed that substance use and victimization (sexual harassment and bullying) were significant predictors of suicide attempts. Elevated depressive symptoms and the use of pain relievers increased the risk. For suicidal ideation, victimization and depressive symptoms were significant predictors. Concerning physical self-harming behavior, substance use and risky behaviors increased odds, whereas binge drinking had varying effects. Victimization variables and health measures were also significant predictors. Dietary patterns, social bonding measures, and self-motivation were found to be protective factors, as they decreased the likelihood of suicidal and self-harming behaviors, highlighting the critical role of strong social connections, healthy dietary habits, and well-being.

Background: The intricate role of pain in non-suicidal self-injury (NSSI) makes the investigation of alterations in brain function during pain processing a critical yet underexplored topic. The aim of this study was to investigate fNIRS correlates of experimental pain and how these differed between adolescent patients engaging in NSSI and healthy controls., Methods: 154 adolescent patients with NSSI and 48 healthy controls underwent a heat pain stimulation with linearly increasing temperature from 32 °C to max. 50 °C, during which fNIRS activity was recorded. Associations between fNIRS activity and pain perception (i.e. pain threshold, pain tolerance and pain intensity) were examined using linear mixed models and linear regression analyses., Results: Across groups, we found a decrease in prefrontal oxygenation during increasing pain stimulation: Oxygenated hemoglobin was higher during baseline than during pain threshold (b = -0.36, p < .001) and higher during pain threshold than during pain tolerance (b = -0.10, p < .001). We did not find differential patterns of prefrontal oxygenation across the pain assessment between patients and healthy controls. Also, no association between pain intensity and fNIRS activity was found., Limitations: fNIRS was only recorded in prefrontal regions and our design did not include a non-painful stimulation as a control condition., Conclusion: While our study adds to the understanding of prefrontal hemodynamic changes associated with pain processing, it did not contribute further evidence to the few existing findings regarding altered neural processing of pain in adolescents engaging in NSSI., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Nonsuicidal self-injury (NSSI) and negative body image are both highly prevalent among adolescents, and there are theoretically proposed reciprocal associations between them. However, previous research has not differentiated between stable personal traits and time-varying state levels when examining these associations, and the underlying mechanisms remain unclear. To address these gaps, this study investigated the longitudinal associations between negative body image, self-disgust, and NSSI among Chinese adolescents, disentangling the between- and within-person effects by employing random intercept cross-lagged panel models (RI-CLPMs). A total of 515 Chinese adolescents (50.7% boys; baseline M age  = 12.34 years, SD = 0.47) participated in a four-wave longitudinal study with 6-month intervals. The results indicated that, at the between-person level, higher levels of self-disgust were associated with more NSSI and more concerns about general appearance, facial appearance, shortness, and fatness, but were not associated with concerns about thinness. At the within-person level, general appearance concern and NSSI positively predicted each other over time through self-disgust. Concerns about facial appearance, shortness, and fatness all positively predicted self-disgust, which in turn positively predicted NSSI over time, but not vice versa. These findings highlight the stable and trait-like associations between self-disgust, NSSI, and most negative body image dimensions. Self-disgust is worth considering as a target for intervention, as it plays a mediating role in the long-term associations between negative body image and NSSI., Competing Interests: Compliance with Ethical Standards. Conflict of Interest: The authors declare no competing interests. Ethical Approval: All materials and the procedure of this study were approved by the Human Research Ethics Committee for Non-Clinical Faculties at South China Normal University, where the first and corresponding authors were affiliated during this research project. Informed Consent: Informed consent was obtained from participating adolescents and their legal guardians. No animals were involved in this study., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

In the past several years, children and adolescents have increasingly been enticed into playing dangerous and challenging games, particularly through social networks. Epidemiological data regarding this phenomenon are particularly difficult to come by, as is information regarding the somatic and psychological consequences of these activities, which can end up having fatal outcomes. We here report the case of a suspicion of child abuse that turned out to be due to participation in a challenge game known as "The Deodorant Challenge" by a 10-year-old child who presented with burn-like lesions. Collaboration with the police and assessment of the psychopathological profile of the child allowed the self-inflicted nature of the injuries to be identified, thereby allowing intrafamilial abuse to be ruled out as the cause of the injuries., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Nonsuicidal self-injury (NSSI) has become a major public health issue in adolescents. This cross-sectional case-controlled study aims to assess the impact of identity diffusion, psychopathology, and mentalization on NSSI in adolescence., Methods: The study sample consisted of 153 adolescents (76.5% girls; M age  = 15.6 years). The sample included 56 clinical cases of NSSI, 45 psychiatric cases without NSSI, and 52 healthy controls, all recruited in Ankara, Türkiye, from June 1, 2022, to August 31, 2022. Mentalization was assessed by "The Movie for the Assessment of Social Cognition" (MASC) which categorizes mentalizing as "correct mentalizing" "hypermentalizing" "undermentalizing" and "no-mentalizing". All participants filled in the Self-Injurious Behavior Screening Questionnaire, Assessment of Identity Development in Adolescence (AIDA), and Youth Self Report (YSR), and Inventory of Statements About Self-injury (ISAS)., Results: The NSSI group showed lower mentalizing capacity than the healthy control group (p = .011), and more no-mentalizing errors than the other two groups (p = .014). Identity diffusion scores were higher in the NSSI group than in the other two groups (p < .001). Multivariate logistic regression analysis showed that the presence of maternal psychiatric disorder (p = .019, OR = 5.21), identity diffusion (p = .007, OR = 1.02), no mentalizing (p = .049, OR = 1.28), and total psychopathology symptoms (p = .009, OR = 1.12) had a significant impact on NSSI., Conclusions: Current findings suggest that transdiagnostic approaches, including mentalization and identity diffusion, may contribute to a more comprehensive understanding of NSSI and to the development of clinical interventions., (© 2024 The Author(s). Journal of Adolescence published by John Wiley & Sons Ltd on behalf of Foundation for Professionals in Services to Adolescents.)

Non-suicidal self-injury (NSSI) is common among adolescents and is associated with a range of detrimental consequences. Family, teachers, and friends are essential sources of social support for adolescents. Increased social support from these sources may reduce NSSI behaviors among adolescents. However, it is uncertain if each source of social support retains its significance when their influences are evaluated simultaneously, and how each source influences the others to impact NSSI behaviors. To address this gap, this research investigated the direct and indirect effects of each source of social support on adolescent NSSI using cross-lagged panel model (CLPM), as well as whether these relationships varied by sex. A total of 3098 Chinese adolescents with a range of 10 to 15 years old (Mage = 13.27, SD = 0.73, 42.4% girls) completed assessments on three waves across approximately two years. The results indicated that teacher support compared to family and friend support showed the strongest association with NSSI behaviors and mediated the relationship between family support and NSSI. These findings highlight teacher support as a hub in the role of social support on NSSI and emphasize the importance of the connections between teacher and family support., Competing Interests: Compliance with ethical standards. Conflict of interest: The authors declare no competing interests. Ethical approval: Ethical approval was obtained from the Institutional Review Board and Ethics Committee of Human Participant Protection, Faculty of Psychology at Beijing Normal University. The procedures used in this study adhered to the tenets of the Declaration of Helsinki. Informed consent: Participants and their primary caregivers gave written informed consent for the assessment., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Longitudinal studies exploring the role of early personality vulnerabilities as risk factors for later NSSI dynamics are scarce. In this study, we assess how pre-adolescent borderline personality pathology (BPP) traits (assessed at mean age 12.78; SD age = 1.38, age range = 7.17-14.78) shape dynamic links between daily socio-emotional dysregulation and NSSI thoughts during emerging adulthood ( M age = 20.96, SD age = 1.63). Mothers of 131 children completed questionnaires about their child's BPP traits in pre-adolescence. These children were re-assessed eight years later and were asked to complete a daily diary for 14 consecutive days. During these 14 days, behavioral and emotional dysregulation as well as NSSI thoughts were self-reported. Multilevel structural equation modeling was used (1) to examine dynamic links between socio-emotional dysregulation manifestations and NSSI thoughts in early adulthood, and (2) to explore the role of pre-adolescent BPP traits in moderating these early-adult dynamic associations. Our findings suggest that young adults who were described by their mothers as high on BPP traits (especially anxious and paranoid traits) during pre-adolescence, tended to respond more with NSSI thoughts when experiencing dysregulation or when perceiving others as rejecting in young adulthood. Results are discussed in terms of potential targets for indicated prevention of NSSI development.

Background: Suicidal ideation and behavior and non-suicidal self-injury (NSSI) among Black emerging adults is a major public health concern. Intimate partner violence (IPV) is a significant risk factor for suicidal ideation and behavior and NSSI, but there is little work examining the buffering effect of psychological well-being (PWB). The purpose of this study was to examine the associations between IPV, suicide ideation and behavior, and NSSI, and the moderating role of PWB on these associations., Method: Secondary data analyses were conducted using a subsample of Black American emerging adults (N = 4694) from the National College Health Assessment., Results: IPV was associated with greater odds of suicide ideation, past-year suicide attempt, and NSSI. PWB was associated with lower odds of suicide ideation, past-year suicide attempt, and NSSI. PWB did not moderate the relationships between IPV and the outcomes., Conclusions: IPV was a risk factor for suicidal ideation, suicide attempt, and NSSI among Black American emerging adults. PWB was associated with lower suicidal ideation and behavior and NSSI engagement, suggesting it can be a protective factor. Bolstering PWB in Black communities may be beneficial in intervention and prevention efforts., (© 2024 American Association of Suicidology.)

Objectives: The associations between childhood maltreatment (CM) and mobile phone addiction (MPA), as well as non-suicidal self-injury (NSSI) have been extensively explored. However, the dose-response relationship between CM and NSSI remains inconsistent. Furthermore, there is limited understanding of the potential mediation effect of MPA on the relationship between CM and NSSI. This study aimed to explore the dose-response relationship between CM and NSSI and investigate the potential mediating role of MPA in this relationship., Study Design: Cross-sectional study. Cross-sectional study., Methods: In the cross-sectional study, a total of 21481 adolescents were selected using a multi-stage cluster sampling method in China. CM, MPA, and NSSI were obtained via self-reports. Data were analyzed using logistic regression models, restricted cubic spline (RCS) functions, and mediation models., Results: A total of 38.1 % of adolescents reported engaging in NSSI at least once. Compared with participants without CM, participants with more types of CM (cumulative childhood maltreatment, CCM) had a higher risk of NSSI (P-trend in all models <0.001). RCS further confirmed the dose-response relationships between the continuous change in CM (scores) and the risk of NSSI (P for non-linearity <0.001). Mediation analysis indicated that the relationship between CM (scores) and NSSI was mediated by MPA, and the indirect effect (β = 1.07 × 10 -3 , 95 % CI: 9.62 × 10 -4 , 1.19 × 10 -3 ) accounted for 22.23 % of the total effect., Conclusions: There was a dose-response relationship between CM and the NSSI, and the relationship was mediated by MPA. Interventions targeting MPA may reduce the risk of NSSI among adolescents who have experienced CM, particularly those with CCM., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Appetitive and aversive motivation are prominent in theories of dysregulated behaviors. The authors conducted a meta-analysis of the association between individual differences in appetitive and aversive motivation and several dysregulated behaviors (i.e., alcohol use, marijuana use, tobacco use, binge eating, aggression, gambling, and nonsuicidal self-injury). Alcohol use ( r = .17, k = 141), marijuana use ( r = .13, k = 23), aggression ( r = .22, k = 52), and gambling ( r = .08, k = 55) were all significantly positively related to appetitive motivation. Binge eating ( r = .28, k = 34) and self-injury ( r = .17, k = 10) were significantly positively related to aversive motivation. Effect sizes were similar to the median effect size in personality research. Together, these results provide some evidence that some dysregulated behaviors are more correlated with approach motivation, whereas others are more correlated with aversive motivation, which may indicate distinct etiological pathways., Competing Interests: Declarati on of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.